Not So Benign Chest Pain in the Young: A Story of Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia.

Spontaneous coronary artery dissection (SCAD) is a rare clinical entity, often presenting similar to atherosclerotic acute coronary syndrome (ACS), although it is a non-atherosclerotic, non-traumatic, and non-iatrogenic coronary artery pathology. We report the case of a 36-year-old woman who presented with substernal, pressure-like chest pain without aggravating, alleviating, or associated symptoms. Initial evaluation revealed elevated troponin levels which peaked at 8.71 ng/mL. Electrocardiogram showed borderline J point elevation in the lateral leads. A transthoracic echocardiography revealed mild left ventricular dysfunction with an estimated ejection fraction of 45% to 50%, an akinetic apex with hyperdynamic basal segments, suggestive of stress cardiomyopathy. However, a left anterior descending artery (LAD) infarction could not be excluded. Emergent coronary angiography revealed SCAD of the LAD. No coronary interventions were performed. The patient was managed medically with dual antiplatelet therapy and beta-blockers. Given the high suspicion for fibromuscular dysplasia (FMD), computed tomographic angiography (CTA) of the head to pelvis was performed. The CTA neck showed bilateral focal areas of mild stenosis and dilation of the distal cervical internal carotid artery, and CTA abdomen revealed multiple splenic artery aneurysms, diagnostic of FMD. Unlike atherosclerotic ACS, our patient was managed medically without percutaneous intervention. This case illustrates the rare occurrence of myocardial injury due to SCAD which results in spontaneous intramural hematoma formation rather than atherosclerotic plaque rupture typically seen in ACS. FMD remains the most commonly associated condition with SCAD.

Características eletrocardiográficas do gênero feminino / Electrocardiographic features female

As diferenças entre os gêneros também se manifestam nos traçados eletrocardiográficos. Essas particularidades se expressam desde alterações sutis no eletrocardiograma normal, com características próprias das ondas, desde o nascimento até além da idade adulta. Peculiaridades do gênero, como gestação e climatério, também influenciam o traçado eletrocardiográfico. Tais mudanças hormonais vão se expressar inclusive na presença de eletrocardiogramas patológicos, como no infarto agudo do miocárdio, nas arritmias e nas valvopatias, tornando especial o eletrocardiograma da mulher, cuja interpretação é, muitas vezes, um desafio...